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Domenico Inzitari

Publications and source records attributed to Domenico Inzitari.

At least 37 records · Page 2Linked to original sources
PubMed2005

Impact of age-related cerebral white matter changes on the transition to disability -- the LADIS study: rationale, design and methodology.

Age-related white matter changes (ARWMC) on brain MRI have been associated with cognitive, motor, mood and urinary disturbances. These factors are known to contribute to disability in elderly people, but the impact of ARWMC and of their progression on the transition to disability is not determined. The LADIS (Leukoaraiosis and Disability in the Elderly) study aims at assessing the role of ARWMC as an independent predictor of the transition to disability in initially nondisabled elderly (65-84 years). Subjects who are not impaired or impaired on only 1 item of the Instrumental Activity of Daily Living (IADL) scale, presenting with different grades of ARWMC severity, were enrolled. Eleven European centers are involved. All the patients were assessed at baseline using an extensive set of clinical and functional tests including global functioning, cognitive, motor, psychiatric and quality of life measures. MRI studies were performed at baseline and will be repeated at the end of the follow-up period to evaluate changes of ARWMC and other lesions. ARWMC were categorized into mild, moderate or severe using the scale of Fazekas et al. For each ARWMC severity class, the primary study outcome is the transition to disability defined as an impairment on 2 or more IADL scale items. Secondary outcomes are the occurrence of dementia, depression, vascular events or death. Six-hundred and thirty-nine subjects (mean age 74.13 +/- 5.0 years, M/F: 288/351) were enrolled in a hospital-based setting and are being followed up for up to 3 years. The large and comprehensive set of measures in LADIS enables a comprehensive description of their functional and clinical features to be examined in relation to different morphological patterns and severity of ARWMC. The longitudinal design will give insight into the possible role of ARWMC and their progression as an independent contributor to disability in the elderly, eventually helping to develop preventive strategies to reduce the burden of disability in late life. The study results may also help to standardize, on an international basis, tools and criteria to identify early stages of disability.

Activities of Daily Living↗
PubMed2005

Calcium channel blockers and stroke.

The most frequent indication for Calcium Channel Blockers (CCBs) is their use as antihypertensive agents for primary or secondary stroke prevention. Hypertension contributes to virtually all mechanisms of stroke, of atherothrombotic, lacunar, cardioembolic and intraparenchymal hemorrhage types. In comparison with the rather univocal mechanisms underlying coronary artery or peripheral artery disease, the variable mechanisms of stroke are the main reason explaining not only the different impact of vascular risk factors, but also the different effects of drugs given for prevention. In an acute stroke setting, lowering blood pressure is potentially harmful, especially if it is carried out using short-acting dihydropyridine derivatives. Some CCBs, such as nicardipine, are preferred in certain conditions (including acute thrombolysis). In stroke, CCBs may also play a role as neuroprotectants. Then twofold effect--against vessel wall changes and as neuroprotectants (after ischemia or degenerative insults)--make this class of drugs of interest for their possible application in the setting of dementias, particularly that of vascular dementia. Some CCBs have been tested and are of benefit when used for preventing or treating cerebral vasospasm after subarachnoid hemorrhage. CCBs must be considered effective in preventing stroke in hypertensive patients. In comparison with other antihypertensive agents, their effects are similar to or even better than those exerted by other drugs. This may be due to the fact that stroke includes different types, with differing underlying pathophysiological mechanisms. The anti-atherosclerotic properties of CCBs may be useful in preventing the atherothrombotic type of stroke at the large pre-cerebral artery level. Dihydropyridinic derivatives may play a selective role in relation to small-vessel disease of the brain, which leads to multiple stroke-associated conditions, including lacunar infarct, intra-cerebral hemorrhage and subcortical vascular dementia. Oral nimodipine is recommended in the prevention/treatment of cerebral vasospasm following subarachnoid hemorrhage (SAH). CCBs, particularly nimodipine, may be of some benefit in vascular or mixed degenerative and vascular dementia or, taking into account subtypes, more selectively in subcortical vascular dementia. In this setting, CCBs may contribute toward reducing the risk of recurrent stroke in patients who are usually at high risk of recurrence.

Aged↗
PubMed2004

Risk factors and health determinants in older Italians.

BACKGROUND AND AIMS: According to a WHO estimate, 50% of the total burden of diseases in men and 25% in women for the EURO-A group (which includes the highly developed countries of the WHO European Region) are attributable to unhealthy life-styles. The aim of the present study was to analyze anthropometric, biochemical and behavioral risk factors using data from the Italian Longitudinal Study on Aging (ILSA), a population-based study of older Italians initiated in 1992 to study those chronic conditions and attendant risk factors that contribute most substantially to morbidity, disability and mortality. METHODS: In this descriptive study, we calculated the means and distribution of risk factors in a sample of 5632 Italian subjects aged 65-84 by gender, age class and geographic area, and identified the proportion of these subgroups at higher risk. Analyses include data from the first (1992-93) and second (1995-96) examinations of this cohort. RESULTS: Over 64% of older Italian participants were overweight in 1992. More than 70% had blood pressure in the borderline or definitely hypertensive range, and almost one-third had hyperlipidemic serum cholesterol levels, including subjects receiving treatment for these conditions. Based on Body Mass Index, more women than men were obese (27 vs 15%) and more women than men were hyperlipidemic in all age classes (38 vs 23%). Approximately 13% of the sample had glucose levels exceeding the recommended 126 mg/dL. Men were found to consume on average about 41 grams of alcohol daily and women 17 g/d. Lastly, we found that approximately 20% of men and 8% of women were smokers in 1992 but that smoking tended to diminish with age. CONCLUSIONS: As the Italian population rapidly ages, the burden of disease and disability is increasing, necessitating more focused, immediate and effective prevention programs. We have identified a number of critical concerns ripe for intervention. The results of this study can better focus such efforts and help guide long-term health planning and policy.

Aged↗
PubMed2003

Leukoaraiosis: an independent risk factor for stroke?

BACKGROUND: Leukoaraiosis, a term that defines an abnormal appearance of the subcortical white matter of the brain on neuroimaging (bilateral patchy or diffuse areas of low attenuation on CT or hyperintense T2 MR areas), has gained evidence in retrospective studies to demonstrate its association with stroke and in prospective studies to demonstrate its prognostic value related to the occurrence of stroke, both ischemic and hemorrhagic, or the occurrence of vascular death. SUMMARY OF REVIEW: The subtype of ischemic stroke most strongly predicted by leukoaraiosis is lacunar infarct, which is likely caused by the same underlying small-vessel pathology. Leukoaraiosis has been shown to predispose to intracerebral hemorrhage at both the basal-ganglionic and lobar sites, primarily when leukoaraiosis is extensive and patients are treated with anticoagulants because of prior ischemic events. CONCLUSIONS: Leukoaraiosis shares with stroke common pathophysiological mechanisms and, because it is likely an expression of the same disease, must be regarded as an intermediate surrogate of stroke rather than a true stroke risk factor.

Brain↗
PubMed2003

Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry.

BACKGROUND AND PURPOSE: The information on the existence of sex differences in management of stroke patients is scarce. We evaluated whether sex differences may influence clinical presentation, resource use, and outcome of stroke in a European multicenter study. METHODS: In a European Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin Scale). RESULTS: Overall, 2239 patients were males and 2260 females. Compared with males, female patients were significantly older (mean age 74.5+/-12.5 versus 69.2+/-12.1 years), more frequently institutionalized before stroke, and with a worse prestroke Rankin score (all values P<0.001). History of hypertension (P=0.007) and atrial fibrillation (P<0.001) were significantly more frequent in female stroke patients, as were coma (P<0.001), paralysis (P<0.001), aphasia (P=0.001), swallowing problems (P=0.005), and urinary incontinence (P<0.001) in the acute phase. Brain imaging, Doppler examination, echocardiogram, and angiography were significantly less frequently performed in female than male patients (all values P<0.001). The frequency of carotid surgery was also significantly lower in female patients (P<0.001). At the 3-month follow-up, after controlling for all baseline and clinical variables, female sex was a significant predictor of disability (odds ratio [OR], 1.41; 95% CI 1.10 to 1.81) and handicap (OR, 1.46; 95% CI 1.14 to 1.86). No significant gender effect was observed on 3-month survival. CONCLUSIONS: Sex-specific differences existed in a large European study of hospital admissions for acute stroke. Both medical and sociodemographic factors may significantly influence stroke outcome. Knowledge of these determinants may positively impact quality of care.

Adolescent↗
PubMed2003

Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project.

BACKGROUND AND PURPOSE: Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype, severity, and prognosis are different in diabetic and nondiabetic patients. We sought to evaluate stroke features, prognosis, and functional outcome in patients with diabetes compared with patients without diabetes. METHODS: In a European Union Concerted Action involving 7 countries and 4537 patients hospitalized for a first-in-a-lifetime stroke, defined according to the Oxfordshire Community Stroke Project criteria, we collected data on demographics, risk factors, clinical presentation, and outcome. We used logistic regression to examine the relationship between diabetes and outcome at 3 months (disability, handicap, and death), controlling for risk factors, clinical presentation, and demographics. RESULTS: Overall, diabetes was present in 937 patients (21%). Diabetic patients, compared with those without diabetes, were more likely to have limb weakness (P<0.02), dysarthria (P<0.001), ischemic stroke (P<0.001), and lacunar cerebral infarction (P=0.03). At 3 months, the case fatality rates were not higher in the diabetic groups (P=0.33). Handicap (Rankin Scale) and disability (Barthel Index) were significantly higher in diabetic patients (P=0.005 and P=0.016, respectively). CONCLUSIONS: Stroke in diabetic patients has a specific clinical pattern and a poor prognosis in terms of motor function, which emphasizes the need for early diagnosis and treatment of every case of diabetes.

Adolescent↗
PubMed2003

Activities of daily living and global functioning.

Disability is a major negative consequence of aging, with impact on several domains of individual, familial, and social life, and a major source of expenditure for social systems. Preventing or delaying disability in the elderly depends not only on understanding the etiology of pathological processes causing disability, but also on the identification of the early stages of disability (preclinical disability). Vascular dementia may have an impact on disability with variable severity and patterns compared to nonvascular forms of dementia. Vascular cognitive impairment is consistent with a preclinical disability status in which cognitive impairment, already manifested, might not interfere substantially with everyday life activities, but might still cause subtle difficulties in selective performances, like those linked with executive functions. Instruments comprehensive and sensitive enough to describe global function in such a context should be specifically designed and validated.

Activities of Daily Living↗
PubMed2003

Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging.

OBJECTIVES: To analyze the relationship between serum total cholesterol (TC) and all-cause mortality, taking into account various potential confounders. DESIGN: Population-based prospective cohort study. SETTING: Older Italians residing in the general community. PARTICIPANTS: Four thousand five hundred twenty-one men and women aged 65-84. MEASUREMENTS: Vital status data were available for 1992-95. The hazard ratios of dying for subjects in the second, third, and fourth quartiles compared with the first quartile of TC were computed using Cox proportional hazards, adjusting for lifestyle factors, anthropomorphic and biochemical measures, preexisting medical conditions, and frailty indicators. RESULTS: Blood samples were obtained from 3,295 (73%) of the participants, of whom 399 died during almost 3 years of follow-up. Low TC was associated with a higher risk of death. Those with TC in the second, third, and fourth quartiles (TC>189 mg/dL or 4.90 mmol/L) had lower hazard ratios (HRs) of death than subjects in the first quartile (0.57, 95% confidence interval (CI) = 0.38-0.87; 0.56, 95% CI = 0.36-0.88; and 0.53, 95% CI = 0.33-0.84, respectively). Few subjects taking lipid-lowering drugs (LLDs) were in the lowest quartile of cholesterol, suggesting that these individuals have low TC values for reasons other than LLD use. CONCLUSION: Subjects with low TC levels (<189 mg/dL) are at higher risk of dying even when many related factors have been taken into account. Although more data are needed to clarify the association between TC and all-cause mortality in older individuals, physicians may want to regard very low levels of cholesterol as potential warning signs of occult disease or as signals of rapidly declining health.

Aged↗
PubMed2003

Acute inflammatory events and ischemic stroke subtypes.

BACKGROUND: Recent studies have suggested that previous infection may be a risk factor for ischemic stroke mainly in young and middle-aged patients. The present study sought to further investigate the association between recent inflammatory events (IE) and ischemic stroke without age restriction and to determine the role of recent IE in different ischemic stroke subtypes. METHODS: We performed a case-control study with 93 consecutive hospitalized stroke patients and 200 (107 hospital and 93 community) controls. Acute IE, both infective and non-infective, occurring in the previous 30 days were assessed using a standard questionnaire. The TOAST criteria were used for ischemic stroke subtypes classification. RESULTS: Acute IE in the previous 30 and 7 days were significantly and independently associated with ischemic stroke (37/93 vs. 47/200; OR 2.23, 95% CI 1.26-3.96 and 17/93 vs.16/200; OR 2.45, 95% IC 1.11-5.39, respectively). Stratifying for stroke subtypes, acute IE significantly and independently increased the risk of atherothrombotic (OR 5.72, 95% CI 2.14-15.25) and cardioembolic stroke (OR 3.02, 95%CI 1.20-7.63). CONCLUSIONS: Acute IE increase the risk of acute ischemic stroke of atherothrombotic and cardioembolic type independently of other predisposing factors. Implications for daily clinical practice, in relation to prevention and treatment of IE in patients at risk, have to be explored.

Acute Disease↗
PubMed2003

Stroke in an elderly population: incidence and impact on survival and daily function. The Italian Longitudinal Study on Aging.

BACKGROUND: Epidemiological data are essential to estimate the burden of stroke. We evaluated stroke incidence in older Italians and the effect of first-ever stroke on survival and activities of daily living (ADL). METHODS: The analysis was performed in the Italian Longitudinal Study on Aging (ILSA) sample, consisting of 5,632 individuals aged 65-84. The ILSA aims at major cardiovascular and neurological age-associated diseases. The baseline survey was performed in 1992 to detect prevalent diseases. The longitudinal examination started on September 1995 aiming at incidence, function and survival. RESULTS: Complete follow-up data were achieved for 77% of the baseline stroke-free cohort (4,164 persons; 50.9% males; mean age 74.5 +/- 5.7 years). Incidence for first-ever stroke was 9.51 (95% CI: 7.75-11.27) per 1,000 person years and 12.99 (95% CI: 10.99-14.98) including recurrent stroke (total incidence). Crude mortality was 49.2% among first stroke patients and 15% among persons without stroke. The first-ever stroke mortality risk ratio, adjusted for demographics and comorbidity, was 2.40 (95% CI: 1.62-3.54). In survivors, impairment of at least one ADL was present in 67.6% of first-ever stroke patients vs. 31.6% of individuals without stroke. The comorbidity-adjusted OR was 2.63 (95% CI: 1.20-5.78) in the total cohort, and 4.00 (95% CI: 1.39-11.46) in individuals without disability at baseline. CONCLUSIONS: The ILSA provides the first data on stroke incidence in Italy on a national basis. Overall, 153,000 new cases can be expected annually in the Italian elderly population. First-ever stroke still has a strong effect on survival and function of older persons.

Activities of Daily Living↗
PubMed2003

A prospective community-based study of stroke in Southern Italy: the Vibo Valentia incidence of stroke study (VISS). Methodology, incidence and case fatality at 28 days, 3 and 12 months.

BACKGROUND AND PURPOSE: Data on stroke morbidity are lacking in southern Italy, an area with about 20 million inhabitants and a mean income lower than the rest of the country. Therefore a population-based stroke register was established to determine incidence and case fatality in the Province of Vibo Valentia, Calabria. METHODS: The survey was conducted among the 179186 residents. Standard definitions and multiple case-finding procedures were employed. All identified cases of first-ever stroke were followed at 28 days, 3 and 12 months. The registration started on January 1, 1996, and ended on December 31, 1996. RESULTS: A total of 321 first-ever-in-a-lifetime strokes were identified. The crude annual incidence rate was 1.79 (95% CI 1.60-1.99) per 1000 inhabitants. Rates age-standardized to the 1996 Italian population and to the standard European population were, respectively, 1.99 (95% CI 1.79-2.20) and 1.36 (95% CI 1.19-1.53) per 1000 inhabitants. A subtype diagnosis was reached in 96% of patients. The crude annual incidence rates per 1000 inhabitants were 1.31 for cerebral infarction, 0.35 for intracerebral hemorrhage, 0.06 for subarachnoid hemorrhage, and 0.07 for unspecified stroke. Overall case fatality was 23.7% at 28 days, 27.4% at 3 months and 40.2% at 12 months. CONCLUSIONS: This is the first prospective population-based stroke register established in southern Italy. Incidence and case fatality were comparable to those previously reported in northern and central Italy and other industrialized countries. Our estimates are useful for developing management services and allocating resources.

Adolescent↗
PubMed2002

Cognitive impairment and chronic cerebral hypoperfusion: what can be learned from experimental models.

The relation between chronic cerebral hypoperfusion and cognitive functions has not been completely clarified. The resolution of cerebral hypoperfusion states, such as those induced by arteriovenous malformations or carotid stenosis/occlusion, has been reported to improve mental decline in humans. Subcortical vascular dementia is another human condition supposed to be linked with chronic cerebral hypoxia/ischemia. The extent of this cause/effect relation is, however, difficult to be assessed in humans, where different factors, such as ageing or subtle degenerative processes, can coexist and interact influencing cognitive performances. Experimental studies can help to elucidate this relation because they can use models of pure chronic/moderate cerebral hypoperfusion. An experimental model of chronic ischemia is the bilateral common carotid artery occlusion in the rat. In this paper, we present a review of experimental studies that evaluated cognitive functions in the rat with bilateral common carotid artery occlusion. We then present an experimental model of bilateral common carotid artery occlusion in the rat modified with respect to previous papers regarding both the surgical procedure and the neurocognitive evaluation that is focused on cognitive domains depending on subcortical-frontal circuits. We propose this model to investigate subcortical vascular dementia.

Animals↗
PubMed2002

Persistent impairment of gait performances and working memory after bilateral common carotid artery occlusion in the adult Wistar rat.

BACKGROUND: The clinical and pathophysiological effects of a chronic reduction of cerebral blood flow in humans are not completely known. We investigated whether rats subjected to bilateral common carotid artery occlusion (bCCA-o) developed focal neurological deficits, gait dysfunction, and working memory alterations. METHODS: Eighteen male Wistar rats were subjected to bCCA-o, 13 were sham-operated. We assessed sensorimotor functions, gait on a 60 cm-long elevated bridge, and working memory (object recognition and Y maze tests) before and 30, 60, and 90 days after surgery. Histological analysis was performed in a subgroup of 10 rats. RESULTS: No rat showed sensorimotor alterations after surgery. Although gait performances of both bCCA-o and sham-operated rats declined over time, the differences reached statistical significance only for the bCCA-o group (mean+/-SE: 26.8+/-5.0; 22.4+/-4.9; 24.5+/-5.5 cm at 30, 60, and 90 days, respectively) in comparison with baseline (52.9+/-5.2 cm; P<0.05). At 60 and 90 days, bCCA-o rats in comparison with sham-operated rats showed decreased performances on object recognition (discrimination index: 0.15+/-0.03 vs. 0.29+/-0.05 at 60 days and 0.10+/-0.04 vs. 0.41+/-0.07 at 90 days; P<0.05) and on Y maze test (alternating rats: 9.9 vs. 85.7% at 60 days and 16.6 vs. 100% at 90 days; P<0.01). In none of the animals were cerebral infarcts detected. Selective neuronal necrosis was observed in the cortex and hippocampus of both bCCA-o and sham-operated rats without any obvious difference. CONCLUSIONS: bCCA-o in the Wistar rat induces persistent and progressive gait and working memory impairment without producing sensorimotor deficit or cerebral infarcts. This model may help to elucidate some physiopathological aspects of neurological impairment associated with states of cerebral chronic ischemia.

Animals↗
PubMed2002

Whole brain apparent diffusion coefficient histogram: a new tool for evaluation of leukoaraiosis.

PURPOSE: To test whole brain apparent diffusion coefficient histogram analysis as an alternative approach to visual score for the assessment of leukoaraiosis (LA). MATERIALS AND METHODS: T2 and diffusion weighted images were obtained in 15 elderly patients. LA extension was assessed on T2 weighted images by two observers using a semiquantitative visual score. Apparent diffusion coefficient (ADC) maps of the entire brain were generated and, after exclusion of the skull with manual tracing and of the cerebrospinal fluid (CSF) by application of a threshold value, whole brain (WB)-ADC histogram was obtained. Moreover, a brain volume index (BVI) was calculated on ADC maps as (intracranial volume - CSF volume) /intracranial volume. RESULTS: The kappa inter-observer agreement for LA scoring was 0.69. Manual segmentation of the skull showed a mean inter-operator coefficient of variation below 3%. The median value of whole brain ADC histogram directly correlated with LA extension (P = 0.013). Moreover a significant inverse correlation (P = 0.002) was found between WB-ADC median value and BVI. CONCLUSION: WB-ADC histogram is a reproducible alternative tool for assessing LA extension and severity.

Aged↗
PubMed2002

Incidence of dementia, Alzheimer's disease, and vascular dementia in Italy. The ILSA Study.

OBJECTIVES: To estimate the incidence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in older Italians and evaluate the relationship of age, gender, and education to developing dementia. DESIGN: Cohort incidence study in the context of the Italian Longitudinal Study on Aging. SETTING: Population sample from eight Italian municipalities. PARTICIPANTS: A dementia-free cohort of 3,208 individuals (aged 65-84), individuated after a baseline evaluation performed in 1992 / 93, aimed at detecting prevalent cases. MEASUREMENTS: The dementia-free cohort was reexamined in 1995 to identify incident cases. The Mini-Mental State Examination (cutoff 23 / 24) was employed to screen for dementia. Trained neurologists evaluated the individuals who screened positive. Final diagnoses had to meet Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria for dementia, National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD, and International Classification of Diseases, Tenth Revision criteria for VaD. RESULTS: Before the follow-up examination, 382 individuals had died (232 had reliable information). Of the 2,826 survivors, 2,266 completed the study. Overall, 127 new dementia cases were identified. Average incidence rates per 1,000 person-years were 12.47 (95% confidence interval (CI)=10.23-14.72) for dementia, 6.55 (95% CI=4.92-8.17) for AD, and 3.30 (95% CI=2.14-4.45) for VaD. Both AD and VaD showed age-dependent patterns. Education was protective against dementia and AD. Women carried a significantly higher risk of developing AD (hazard ratio=1.67, 95% CI=1.02-2.75), and men of developing VaD (hazard ratio=2.23, 95% CI=1.06-4.71). CONCLUSIONS: Incidence of dementia in Italy paralleled that in most industrialized countries. About 150,000 new cases per year are expected. A significant gender effect was evidenced for major dementia subtypes. The burden of VaD, especially in men, offers opportunities for prevention.

Age Distribution↗